胆道镜检查中发现胰管开口的临床意义

The clinical significance of an abnormal pancreatic duct outlet found by choledochoscopy

目的探讨胆道镜检查中发现胰管开口的临床意义。方法测量分析１６例病人的胆总管、胰管直径、胰管开口直径、胰胆管夹角、胰胆管共同通道长度，胆汁中淀粉酶含量。结果与结论胆道镜检查中能看到胰管开口的原因是这类病人的胰管较粗，胰胆管夹角较大，共同通道较长。本组１６例病人胆汁中淀粉酶含量有１４例高于２００温氏单位，可能存在胰胆返流，这与胆总管囊肿和胆管癌及胆管结石的形成可能有关。在给这类病人行胆道手术时，为防止胰胆返流，应尽可能将胆总管下段横断。

Objective To evaluate the clinical significance of an abnormal pancreatic duct outlet observed during choledochoscopy. Methods In such 16 cases the diameters of the common bile duct(CBD) pancreatic duct(PC), the diameter of outlet of PC, the angle between CBD and PC (ACBP), the length of the biliary pancreatic duct common channel(BPDCC), and the level of amylase in bile were assessed. Results and Conclusions (1) The reason why the pancreatic duct outlet could be seen during choledochoscopy is that these cases have wider pancreatic ducts, larger ACBP and longer BPDCC. (2) Of these 16 cases, the amylase level in bile above 200 Winslows unit is found in 14 cases, which may indicate that the pancreatic biliary regurgitation is presented in the 14 cases. Such regurgitation can attribute to the formation of CBD cyst and biliary duct carcinoma, and may result in cholelithiasis. (3) When an operation is performed on the patients with this kind biliary duct, the CBD should be transected to prevent pancreatobiliary regurgitation.